1.
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Registered psychiatric nurses require a client-specific order from a health professional before performing any activity that is not within the registered psychiatric nurse’s autonomous scope of practice.
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2.
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Registered psychiatric nurses acting under a client-specific order ensure the ordered activity is:
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a.
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Either one of the restricted activities identified in section 51 or 52 of the Nurses and Midwives Regulation that registered psychiatric nurses may perform when acting under an order or an activity within the registered psychiatric nurse’s autonomous scope of practice,
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b.
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Consistent with BCCM’s ethics standards and practice standards, including any applicable limits and conditions on performing the activity,
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c.
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Consistent with organizational/employer policies, processes, and restrictions, and
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d.
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Within their individual competence.
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3.
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Registered psychiatric nurses acting under a client-specific order ensure that they have the competence to: |
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a.
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Perform the activity safely and ethically,
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b.
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Identify potential risks of the activity to the client and how to minimize those risks,
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c.
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Recognize and manage the intended and unintended outcomes of the activity.
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4.
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Before performing an activity under a client-specific order, registered psychiatric nurses consider applicable employer/organizational policies, processes, restrictions, and resources, and other relevant human and system factors that may impact their ability to:
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a.
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Perform the activity competently and safely within their practice setting, and
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b.
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To manage intended and unintended outcomes of the activity.
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5.
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Registered psychiatric nurses perform advanced activities under a client-specific order only when they have obtained the additional education, training, and/or clinical experience needed to gain and maintain the competence to perform the activity safely.
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6.
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Registered psychiatric nurses acting under a client-specific order ensure that the order:
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a.
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b.
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Is clear and complete, |
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c.
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Is documented, legible, dated and signed with a written/electronic signature, and
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d.
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Contains enough information for the nurse to carry it out safely.
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7.
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Registered psychiatric nurses accept a verbal or telephone client-specific order only when there is no reasonable[3] alternative, according to organizational/employer policies and processes, and when doing so is in the best interest of the client. Nurses repeat the client-specific order back to the ordering health professional to confirm its accuracy and promptly document the order.
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8.
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Registered psychiatric nurses conduct assessments to ensure that the client's condition continues to warrant the activity before acting under a client-specific order.
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9.
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Registered psychiatric nurses may not change or cancel a client-specific order when the activity is outside of the registered psychiatric nurse’s autonomous scope of practice or the registered psychiatric nurse’s individual competence.
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10.
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Registered psychiatric nurses communicate and collaborate with the health professional (or their delegate) who gave the client-specific order, follow organizational/employer policies and processes, take action as needed, and document in the client record, when:
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a.
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The ordered activity may no longer be appropriate because the client’s condition, needs or wishes have changed (e.g., to ‘hold’ the order),
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b.
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They are not able to carry out a client-specific order,
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c.
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The client-specific order does not appear to consider a client’s individual characteristics, values/beliefs, and preferences,
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d.
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The client-specific order does not appear to reflect current evidence or be in the best interest of the client,
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e.
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They change or cancel a client-specific order for activities that are within their autonomous scope of practice, or
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f.
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The safeguards and resources are not available to manage the outcomes of performing the activity, including reasonably foreseeable unintended outcomes.
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11.
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Registered psychiatric nurses follow the standards for Acting within Autonomous Scope of Practice when they change or cancel a client-specific order that is within their autonomous scope of practice and individual competence.
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12.
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Registered psychiatric nurses are responsible and accountable for any changes or cancellations they make to a client-specific order that is within their autonomous scope of practice and individual competence.
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13.
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Registered psychiatric nurses obtain a client-specific order to perform an activity or provide care or a service that is within their autonomous scope of practice when:
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a.
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It is required by organizational/employer policies, processes, or restrictions,
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b.
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There are insufficient organizational/employer supports, processes and resources in place (such as decision support tools or clinical practice documents) to enable the nurse to meet BCCNM standards, limits, or conditions related to the activity, care or service, or
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c.
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The registered psychiatric nurse is competent to perform the activity or provide the care of services but does not have the individual competence to make a nursing diagnosis or carry out an assessment to determine whether the client would benefit from the activity, care, or service, but is competent to carry out the activity.
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14.
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Registered psychiatric nurses ONLY act under a client-specific order from a health professional who is not identified in the Nurses and Midwives Regulation as allowed to give a client-specific order to authorize a registered psychiatric nurse to perform a restricted activity when:
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a.
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The activity is within the registered psychiatric nurse’s autonomous scope of practice, |
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b.
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The registered psychiatric nurse is able to meet BCCNM standards, limits, or conditions related to the activity,
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c.
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The activity is within the registered psychiatric nurse's individual competence, and
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d.
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Organizational/employer policies, and processes exist that:
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i. clarify the accountability and responsibility of the nurse and the non-listed health professional, and
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ii. outline the requirements for the non-listed health professional to complete an assessment and to ensure that the ordered activity is in the best interest of the client.
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